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Infant Lung Disease and Associated Complications

Infant Lung Disease and Associated Complications

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Infant Lung Disease and Associated Complications

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  1. Infant Lung Disease and Associated Complications Mary P. Martinasek, BS, RRT Director of Clinical Education Hillsborough Community College

  2. Respiratory Distress Syndrome • RDS , formerly called Hyaline Membrane disease (HMD) • Primary cause of respiratory disorders • 70% preterm deaths, 30% neonatal deaths • Etiology - deficiency in surfactant • Premature pulmonary system

  3. Risk Factors associated with RDS • Less than 35 weeks gestation • Maternal diabetes • Hx of RDS in sibling • White male • PFC (Persistent Fetal Circulation) • Prenatal maternal complication • Abnormal placental conditions • Umbilical cord disorders

  4. Pathophysiology of RDS Decreased surfactant Wide spread atelectasis    Worsening V/Q & __ Surface Tension _FRC    __ PaO2& __ PaCO2 _WOB __ Compliance   Respiratory Acidosis Stiffer Lungs  Capillary damage Alveolar Necrosis &

  5. Clinical Signs of RDS • Respiratory Rate > 60 bpm • Grunting • Retracting • Nasal flaring • Cyanosis • Hypothermia • CXR = underaeration, opaque, ground glass appearance

  6. Treatment of RDS • Maternal steroids • Artificial surfactant therapy • Adequate hydration • Thermoregulation • Goal = support the patient’s respiratory system while minimizing complications

  7. Complication of RDS • ICH occurs in 40% of < 1500 grams • Barotrauma = pulmonary air leaks • Infection • PDA

  8. Airleak Identification 100 points!!!

  9. ICH - Grade 1

  10. Reverse Jeopardy For 100 points!!! Exactly how many grams equal 1 pound?

  11. Clinical Scenario • 1500 gram infant born at 28 weeks gestation. Exhibiting signs of respiratory distress. • ABG = 7.20 60 (CO2) 45 (02) -6 (BE) • Select an appropriate mode initial of therapy • N.C. @ 2 LPM • Head Hood at 35% • Nasal cpap +4 Fio2=40 %

  12. BPD • Chronic infant who was exposed to long term oxygen and high pressures • Infant on supplemental oxygen for > 30 days exhibiting the classic x-ray findings

  13. Pathophysiology of BPD • Oxygen toxicity • Barotrauma • Presence of PDA

  14. CXR in BPD • Stage I • First 3 days of life • Ground glass appearance on x-ray • Stage II • 3 - 10 days • Opaque, obscure cardiac markings • Stage III • 10 - 20 days • Cyst formations • Stage IV • 28 days • Increased lung density, larger cysts

  15. Stage 1

  16. Stage 2

  17. Stage 3

  18. Stage 4

  19. Treatment of BPD • Avoidance of factors that lead to development • Adequate ventilatory humidification • CPT and bronchodilators • Fluid management • Nutrition

  20. 100 Points!!

  21. Persistent Pulmonary Hypertension • PPHN • Formerly called Persistent fetal circulation (PFC) • R/O Congenital heart disease • Hyperoxia test • Hyperoxia-Hyperventilation test ?? • Echocardiogram

  22. Treatment of PPHN • Nitric Oxide (NO) • Hyperventilation • Tolazoline • Dopamine • ECMO (extracorporeal membrane oxygenation • High frequency ventilation

  23. Reverse Jeopardy • What color tank is NO? • What color tank is NO2? 100 points

  24. Transient Tachypnea of the Newborn • TTN • Aka RDS II • Term infants delivered via cesarean section • Signs of RDS • CXR - streaky infiltrates • R/O pneumonia • Treatment • O2, Cpap if necessary

  25. TTN x-ray 6 hours 2 days

  26. Meconium Aspiration Syndrome • Term and Postterm infants • Asphyxia in utero  blood shifts to vital organs  relaxation of anal sphincter • Gasping respirations  meconium aspirated • Ball valve effect - air trapping • Furthers hypoxemia and hypercarbia • Air leak • Inflammation • Persistent pulmonary hypertension

  27. Diagnosis and Treatment • Aspiration of meconium • Classic sign of RDS • Irregular densities on CXR • Treatment • Suction meconium • Peep • Low peak pressures • Antibiotics • amnioinfusion

  28. MAS x-ray

  29. Asphyxia • Major complication is hypoxic-ischemic encephalopathy • Periventricular leukomalacia • Tubular necrosis of kidneys and GI effects • Liver damage • Lung damage •  PVR, surfactant disruption  RDS

  30. PVL

  31. Wilson- Mikity Syndrome • AKA - Pulmonary dysmaturity • BPD lung changes in unventilated infant • Signs • Hyperpnea, cyanosis, retractions, hypercarbia, respiratory acidosis • Treatment • Supportive • Ventilated to treat apnea • O2 to treat hypoxemia

  32. Air leak syndrome • Increased incidence in RDS, MAS, TTN • Mostly caused by mechanical ventilation • Pneumothorax • Spontaneous vs. tension • ↑ HR, cyanosis, apnea, BP • Transillumination, CXR • Pneumomediastinum • Pneumopericardium • PIE (pulmonary interstitial emphysema) • Peep, high PIP, prolonged I times

  33. PIE x-ray

  34. Apnea • Cessation of breathing leading to bradycardia and/or cyanosis • Nonobstructive apnea (Central) = absence of airflow and ventilatory effort • Obstructive apnea = absence of airflow despite ventilatory effort

  35. Central or Nonobstructive Apnea • Apnea of prematurity • Chemoreceptor sensitivity • Arousal response • Stimulation of airway reflexes • Dysfunction of the respiratory centers • Dysfunction of the ventilatory muscles • Dysfunction of the peripheral nervous system • Treatment = caffeine or theophylline

  36. Obstructive apnea • Anatomic abnormalities • Pierre Robin Syndrome (micronathia) • choanal atresia, laryngeal webs, vocal cord paralysis, enlarged tonsils and adenoids • Treatment = pharmacologic agents, surgery

  37. 100 points What is choanal atresia and what is the classic sign?

  38. Pierre Robin Syndrome

  39. 100 points What is this x-ray terminology for this condition?

  40. Retinopathy of Prematurity • AKA = ROP • Formerly known as RLF (Retrolental Fibroplasia) • Scar formation behind lens of eye • Factors • Immature retinovascularity • Oxygen administration

  41. Pathophysiology • Capillaries begin branching at 16 weeks • Begin at optic nerve and grow toward the ora serrata (anterior end of retina) • Reach ora serrata at 40 weeks • In the presence of high PaO2 vessels constrict  vaso-obliteration (necrosis)

  42. 1 = Partial vascularization with distinct demarcation line 2 = Ridge develops at demarcation line, stopping normal vascular development 3 = Blood vessels within ridge grow wildly toward center of eye, and scar tissue develops. 4 = Scar tissue pulls the retina, causing partial detachment

  43. Treatment of ROP • Cryotherapy = -20 degrees C. Nitrous Oxide behind the eye and freeze the avascular portion of vessel • Complications - scarring, cell destruction, retinal detachment • Laser therapy - photocoagulation • Complication - scarring, choroidal hemorrhage, pain

  44. Intracranial/Intraventricular Hemorrhage • ICH and IVH • Majority of hemorrhages in neonate are periventricular/ Intraventricular (IVH) • Preterm and Infants <1500 grams high risk • Germinal matrix most common